=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154295244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA BLAKE LOWE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 COLISEUM DR
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-5963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-736-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1730 LILLASTON LN
-----------------------------------------------------
City | HAYES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23072-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-269-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------